how to perform epicardial ablation of vt - arrhythmia · pdf filerichard schilling st....
TRANSCRIPT
Epicardial Guide Wire Mapping
• Used with ethanol or venous ablation
• Useful for identification of target vessel
Post op
• CK 300• 6 minutes on ex test no VT off drugs• EP study no VT• Discharged well no further VT
Transpericardial Technique - Best endocardial position
• punctures -heparinisation
• Puncture site adjusted to region of interest
• Obesity• Post-surgical patients
fail if not inferior origin
Pericardial puncture
• Slight resistance felt as diaphragm crossed
• Rubbing of needle• Tenting of
pericardium• Limit contrast• LAO view of wire
Complications of epicardial approach8% RV perf and haemopericardium
Sosa et al JACC 2000
0% Cesario Heart Rhythm 2006
6% transient pericarditis
Schweikert et al Circ 2003
5% transient pericarditis
Personal data
Coronary vessel puncture/transient bleeding
Tedrow et al JCE 2009
Pericardial access
• May be limited in redos• Not usually a problem in post MI• Usually not worth trying in post CABG
NICE Guidelines
• No review by advisors prior to publication• Procedures should only be carried out in
units with cardiothoracic surgery
74 yr male frequent ICD shocks
• VT1 – clinical VT– Tolerated– ATP accelerated– Terminated and
non-inducible after RF at first procedure